Mortality Assessment in Lung Cancer Resection

肺癌切除术中的死亡率评估

• 批准号: 8454228
• 负责人: Benjamin D Kozower
• 金额: $ 14.98万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8454228
• 关键词: Mortality; Assessment; Lung; Cancer; Resection

DESCRIPTION (provided by applicant): Surgical resection remains the optimal therapy for the management of patients with early stage lung cancer. Determining which patients have the greatest capacity to benefit from surgical therapy requires estimating the combined effects of the patient's severity of disease, age, and co-morbid disease on mortality risk. The goal of this application is to investigate mortality assessment following lung cancer resection. Specific Aim 1 will develop and validate an efficient and clinically useful method to estimate patient specific survival following lung cancer resection. A clinically useful tool is needed to facilitate informed clinical decision making, patient counseling and appropriate resource allocation. Specific Aim 2 will determine the specific threshold value of hospital volume at which mortality risk is substantially Increased following lung cancer resection. Most studies of the volume-outcome relationship have used arbitrary thresholds rather than identifying a specific threshold value. This value is imperative to determine the impact of implementing volume based policies on access and delivery of care. Specific Aim 1 will be addressed using detailed clinical data from the Society of Thoracic Surgeons Database. Cox proportional hazard regression will estimate the probability of survival as a function of patient preoperative characteristics. The resulting comprehensive model will be used as the basis of a clinically practical decision support tool for use in estimating patient specific survival. Specific Aim 2 uses the Nationwide Inpatient Sample to identify patients having lung cancer resection. Piecewise polynomial functions (spline regression) will be used to determine the specific threshold value for the volume of lung cancer resections that substantially increases mortality risk following lung cancer resection. This application combines a detailed career development plan along with the research application. With the guidance from Dr. Kozower's advisory committee and the institutional support he will receive. Dr. Kozower will develop the skills required to evolve into an Independent Investigator In health services research. RELEVANCE (See instructions): Lung cancer is the leading cause of cancer death In the United States. Morbidity and mortality following lung cancer resection are common due to the age and comorbidiy of the patients along with the complexity of the treatment. Determining which patients have the greatest capacity to benefit from surgical treatment of lung cancer is crucial as the number of early stage lung cancers is increasing.

描述（由申请人提供）：手术切除仍然是治疗早期肺癌患者的最佳疗法。确定哪些患者最有能力从手术治疗中受益，需要估计患者疾病严重程度、年龄和共病疾病对死亡风险的综合影响。此应用程序的目标是研究肺癌切除术后的死亡率评估。具体目标 1 将开发并验证一种有效的、临床上有用的方法来估计肺癌切除后患者的特定生存率。需要一种临床上有用的工具来促进知情的临床决策、患者咨询和适当的资源分配。具体目标 2 将确定肺癌切除后死亡风险大幅增加的医院容量的具体阈值。大多数关于数量-结果关系的研究都使用任意阈值，而不是确定特定的阈值。该值对于确定实施基于数量的政策对获得和提供护理的影响至关重要。 具体目标 1 将使用胸外科医生协会数据库的详细临床数据来解决。 Cox 比例风险回归将根据患者术前特征来估计生存概率。由此产生的综合模型将用作临床实用决策支持工具的基础，用于估计患者的特定生存率。具体目标 2 使用全国住院患者样本来识别接受肺癌切除术的患者。将使用分段多项式函数（样条回归）来确定肺癌切除体积的具体阈值，该阈值会显着增加肺癌切除后的死亡风险。 该申请结合了详细的职业发展计划和研究申请。在科佐尔博士顾问委员会的指导和他将获得的机构支持下。 Kozower 博士将培养成为卫生服务研究独立调查员所需的技能。相关性（参见说明）：肺癌是美国癌症死亡的主要原因。由于患者的年龄和合并症以及治疗的复杂性，肺癌切除术后的发病率和死亡率很常见。随着早期肺癌数量的不断增加，确定哪些患者最有能力从肺癌手术治疗中受益至关重要。

项目成果

Lung Cancer Resection Volume: Is Procedure Volume Really an Indicator of Quality?

• DOI: 10.1053/j.semtcvs.2012.06.007
• 发表时间: 2012-06-01
• 期刊: SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY
• 影响因子: 2.5
• 作者: Kozower, Benjamin D.;Stukenborg, George J.
• 通讯作者: Stukenborg, George J.

Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality.

肺癌切除术后再入院与术后 90 天死亡率增加 6 倍相关。

• DOI: 10.1016/j.jtcvs.2014.04.026
• 发表时间: 2014-11
• 期刊: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
• 影响因子: 6
• 作者: Hu, Yinin;McMurry, Timothy L.;Isbell, James M.;Stukenborg, George J.;Kozower, Benjamin D.
• 通讯作者: Kozower, Benjamin D.

A thoracic surgeon-directed tobacco cessation intervention.

胸外科医生指导的戒烟干预措施。

• DOI: 10.1016/j.athoracsur.2009.12.046
• 发表时间: 2010
• 期刊: The Annals of thoracic surgery
• 作者: Kozower,BenjaminD;Lau,ChristineL;Phillips,JenniferV;Burks,SandraG;Jones,DavidR;Stukenborg,GeorgeJ
• 通讯作者: Stukenborg,GeorgeJ